- TANF recipients had much higher rates of emergency department use than the general population.
During the study period, emergency department use was 3.7 times greater among TANF adults than among adults in the general population (Figure VII-1).44 Emergency department visits were also more common among TANF children than among children in the general population – the rate was about 1.6 times higher during the 11-month study period.
- The higher rate of emergency department use among both TANF adults and children was common across many diagnostic categories.
Appendix E Figure VII-a compares TANF adults with adults in the general population for the eight most common health problems in emergency department visits, and shows that TANF adults had much higher rates of emergency department use for these diagnostic categories. Appendix E Figure VII-b shows that the rates of emergency department use by TANF children for the seven most common health problems exceeded the rates for children in the general population.
- The higher rates of emergency department use among TANF recipients may reflect problems with health care access.
Use of emergency departments for routine health care is greater when families lack health care coverage or do not have access to a primary care physician. In addition, lack of a “medical home” may result in people waiting until their health problems worsen before seeking help from emergency room personnel. Although most TANF recipients in this study were enrolled in Medicaid (and all would qualify, since TANF clients are “categorically eligible”), they may have used the emergency department for routine health care in cases where access to a health care provider who accepted Medicaid clients was a problem.
- White TANF adults had the highest rates of emergency department (ED) use.
The ED use rate for white TANF adults was 5.5 times greater than for white adults in the general population (as reflected in Figure VII-2). Among non-whites, the ratio for TANF adults to persons in the general population was almost 2.3 to 1.
- The higher rate of emergency department use among white TANF recipients was particularly evident in visits for mental disorders.
Figure VII-4 compares rates of emergency department visits for mental disorders for white and non-white adults. The rate for white TANF recipients was 5.7 times greater than for white adults in the general population, while the rate for non-white TANF recipients was only 1.6 times greater than for non-whites in the general population.
†Rates per 10,000 TANF cases and per 10,000 South Carolina population. Data for adults aged 18-64 visiting the ED between May 2001 and March 2002.
- The findings on emergency department use provide further evidence that white TANF recipients may have different barriers than non-white recipients.
In Chapter IV of the report, it was shown that white TANF recipients in the survey sample had significantly higher rates of physical health problems and mental health problems than black recipients. White recipients were also much more likely to be caring for a sick or disabled child or other family member. The findings on emergency department use are consistent with this overall pattern. In combination, the findings suggest that health-related problems are a more significant reason why whites enroll in TANF than non-whites. The findings also lend support to the more general conclusion that employment barriers among the TANF population may vary significantly among different sub-groups.